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Behavioral Obligation and Information

Avoidance

Article in Annals of Behavioral Medicine · December 2012

DOI: 10.1007/s12160-012-9451-9 · Source: PubMed

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ann. behav. med. (2013) 45:258–263
DOI 10.1007/s12160-012-9451-9
BRIEF REPORT
Behavioral Obligation and Information Avoidance
Jennifer L. Howell, M.S. & James A. Shepperd, Ph.D.
Published online: 6 December 2012
# The Society of Behavioral Medicine 2012
Abstract
Background Although knowledge can be powerful and
bring a variety of important benefits, people often opt to
remain ignorant.
Purpose We propose that people are particularly inclined to
remain ignorant when learning information could obligate
undesirable behavior.
Method In three studies, participants completed an online
risk calculator and then learned that receiving high-risk
feedback from the calculator would obligate them to engage
in a behavior that was either highly undesirable (e.g., un-
dergoing a cervical exam and taking medication for the rest
of their life) or only slightly undesirable (e.g., having their
cheek swabbed and taking medication for 2 weeks). We then
offered participants the opportunity to receive risk feedback
from the calculator.
Results Across all studies, participants more often avoided
feedback when it could obligate highly undesirable behavior
compared with mildly undesirable behavior.
Conclusion People decline learning their risk information
more often when doing so obligates undesirable behavior in
response.
Keywords Information avoidance . Health . Decision
making . Defensive processing . Autonomy
Behavioral Obligation and Information Avoidance
Asking the typical person why he or she avoids some piece
of information will likely yield a response that can be
summarized in one word: fear. But what do people fear? A
J. L. Howell (*) : J. A. Shepperd
Department of Psychology, University of Florida, PO Box 112250,
Gainesville, FL 32611-2250, USA
e-mail: jenny.howell@ufl.edu
recent review proposed that people do not necessarily fear
the information itself, but rather the cognitive, affective, and
behavioral consequences of learning the information [1].
The present study focuses on how the behavioral conse-
quences of information lead to avoidance. To this end, we
focus on one possible motivation for avoidance: learning the
information might obligate undesired action.
Autonomy Concerns
We contend that people are motivated to avoid information
that obligates undesired action at least in part because such
information threatens a basic need for autonomy (i.e., the
ability to determine one’s personal actions). People experi-
ence autonomy when they can select their behavior based on
internal motivations (e.g., personal desires and values) rath-
er than external motivations (e.g., guilt and obligation [2]).
Information can threaten autonomy by obligating people to
engage in a behavior that is not internally motivated. For
example, a physician may tell a patient at high risk for
diabetes to make diet changes such as giving up fried foods.
The patient may perceive these changes as a threat to au-
tonomy because they represent unwanted behaviors that are
not internally motivated.
Researchers have characterized gaining and sustaining
autonomy as a fundamental human desire [3], as an intrin-
sically motivated goal [4], as a key motive underlying
behavior and cognition [5], and as necessary for well-
being [6, 7]. Because a sense of autonomy is such a central
aspect of the self, people naturally react defensively to
threats to their autonomy. For example, people often re-
spond to messages they perceive as constraining their be-
havior by behaving in ways that are directly counter to the
message [8, 9]. By responding defensively, people reassert
their autonomy.
ann. behav. med. (2013) 45:258–263
Autonomy and Avoidance
In the present study, we examined a different type of defen-
sive responding: information avoidance. We propose that
people sometimes avoid learning information if they believe
that the information could require them to engage in an
undesired behavior, which is behavior that is “difficult,
inconvenient, demanding, expensive, or unpleasant” [1] (p.
343). Although we know of no experimental evidence for
heightened avoidance of information that may obligate un-
desired behavior, several self-report studies provide evi-
dence consistent with this notion. When asked why they
were avoiding genetic testing for an unborn child, expectant
parents who had previously given birth to a child with a
genetic defect cited fears that the results would prompt them
to abort the pregnancy [10]. Further, in separate surveys of
South African sex workers [11] and Belgian immigrants
[12], many reported that they avoided HIV screening be-
cause a positive test result would obligate them to take
undesired action. For the sex workers, the undesired action
was giving up a source of revenue. For the immigrants, the
undesired action was reporting their HIV status to the gov-
ernment and thus jeopardizing their citizenship application.
Finally, the primary reason a sample of Nigerian women
with a suspicious lump in their breast reported for not
visiting a physician was fear that they would be required
to have a mastectomy [13].
A limitation of these studies is that they rely on self-
reports, which are often inaccurate [14]. Lacking is experi-
mental evidence demonstrating greater avoidance when the
behavior obligated by the information is highly (as opposed
to moderately) undesirable. To address this gap, we con-
ducted three studies in which we manipulated obligation
experimentally by varying the undesirability of the behav-
ioral consequences of the information. In all three studies,
participants believed they could learn their risk for an en-
zyme deficiency based on their responses to a risk calcula-
tor. In Study 1, participants learned that anyone who
received feedback indicating a high risk for the deficiency
would be required to undergo a non-embarrassing (low
obligation) or highly embarrassing (high obligation)
follow-up examination. In Study 2, participants received
no information about treatment (low obligation) or learned
that treatment entailed taking pills for an unspecified period
of time (high obligation). In Study 3, participants learned
that treatment entailed taking pills for 2 weeks (low obliga-
tion) or for the rest of their life (high obligation). In all
studies, we hypothesized that people would decline to learn
risk information more often when doing so would obligate
more undesirable behavior in response.
Of course, we are not the first to examine people’s
tendency to avoid information. Research on selective expo-
sure has long shown that people prefer to receive
259
information that is consistent with their attitudes over infor-
mation that is inconsistent [15]. However, whereas the se-
lective exposure literature focuses on the choice between
attitude-consistent and attitude-inconsistent information, we
address the larger issue of the choice between receiving
information and not receiving information. Moreover,
researchers largely explain the preference for attitude-
consistent information in terms of dissonance theory—peo-
ple experience dissonance (an unpleasant arousal state) in
response to inconsistency between their cognitions or
behaviors [16]. Research has also proposed that defensive
reactions, like avoidance, may be an attempt to regulate
negative emotions [17] or to maintain personal self-worth
[18, 19]. However, none of these accounts can easily explain
why obligation might cause people to avoid information.
Specifically, although information that obligates unwanted
action may threaten autonomy, it does not clearly create
cognitive inconsistency (i.e., dissonance), produce high neg-
ative emotion, or threaten self-worth. In short, the research
we describe goes beyond research on selective exposure and
defensive processing.
Study 1
Methods
Participants
Participants were 112 undergraduate women (Mage 019.0,
SDage 01.2) who participated in partial fulfillment of a re-
search participation requirement.
Design and Procedure
When participants arrived for the experiment, an experi-
menter dressed in medical scrubs escorted them to work
stations and told them that they would complete a survey
for the university hospital assessing risk for a newly discov-
ered disease. The experimenter then left the room and the
computer-guided participants through the remaining proce-
dures. After consenting to participate, participants watched
one of two informational videos about TAA deficiency [20,
21], a (fictitious) condition modeled after endometriosis that
ostensibly produces a problem with the body’s ability to
process nutrients and that can lead to pain, infertility, and
other physical complications. Participants in the high obli-
gation condition learned that definitive testing for TAA
deficiency required a cervical examination, whereas partic-
ipants in the low obligation condition learned that definitive
testing required a cheek swab.
We chose to use a fictitious disease rather than an exist-
ing one for several reasons. First, factors such as personal
260
knowledge, family history, and perceived risk factors
can dramatically influence people’s thinking about dis-
eases, and we wished to eliminate the influence of these
factors on people’s decision making. Second, using a
fictitious a disease allowed us to hold constant disease
characteristics such as severity, likelihood, controllabili-
ty, and treatability, all of which could overwhelm the
effect of our experimental manipulation of obligation on
decision making. Third, using a fictitious disease
allowed us to tailor the pertinent risk factors and the
onset of symptoms so that they would seem relevant to
a healthy sample of people. Finally, using a fictitious
disease made it possible for us to manipulate obligation
and thereby examine experimentally its effect on deci-
sion making, something that would be impossible with
real diseases. In sum, using an invented disease permit-
ted examination of our hypothesis in a carefully con-
trolled situation.
Eighteen pilot participants indicated on an eight-item
index the extent to which they viewed the two conditions
as threatening to their autonomy. Example items include,
Learning that I am at high risk would… (a) require me to
engage in undesired behavior, (b) obligate me to spend time
in a way I don’t want to, and (c) restrict my freedom to act as
I wish. Participants responded to each item from 10strongly
disagree to 70strongly agree (α for both conditions>.90).
The pilot participants reported that the cervical exam posed
a greater threat to autonomy (M04.9, SD01.4) than did the
cheek swab (M04.3, SD01.1), t (17)02.37, p0.03, d0.561.
After watching the video, participants completed a
(fictitious) risk calculator and then read that the computer
could assess their lifetime risk for TAA deficiency based on
their responses. They also read that if they chose to learn
their risk and the calculator indicated that they were at high
risk, they would be legally obligated by the state to undergo
definitive testing for TAA deficiency within the next
2 weeks. Next, all participants chose between receiving
and not receiving their risk-calculator feedback. Finally,
participants completed items assessing “How serious of a
condition is TAA deficiency?” (10not at all serious; 70very
serious) and “How worried [they were] about developing
TAA deficiency?” (10not at all worried; 70very worried).
The experimenter then fully debriefed participants, probed
for suspicion about the true nature of the study, and
explained that TAA was a fictitious disease.
All procedures were reviewed and approved by the
university Institutional Review Board. We carefully de-
veloped the procedures, including information about
TAA and the instructions that the state would require
1 0%
Although it would have been preferable to examine autonomy con-
cerns among participants who actually completed the decision task,
these items were not included in the experiment.
ann. behav. med. (2013) 45:258–263
definitive testing for high-risk participants, to ensure
they were credible to participants. Supporting the cred-
ibility of our procedures, only four participants across
all three studies reported doubts about the credibility of
the information we provided. Data from these partici-
pants were removed prior to analysis.
Results and Discussion
As evident in Fig. 1, more participants opted to avoid
learning their risk in the high obligation (cervical exam)
condition (66 %) than in the low obligation (cheek swab)
condition (45 %), X2 (1, 112)05.20, p0.02, Φ 0 .22. These
findings show experimentally that people avoid information
that could potentially obligate undesired behavior.
We found no effect of condition on the extent to which
participants worried about developing TAA deficiency or
viewed the condition as serious, ts(110)<.24, ps>.81, r
<.03, indicating that we did not inadvertently manipulate
worry or perceived seriousness. Further, neither of these
variables predicted avoidance behavior (rs<.11) suggesting
that our effects are not due to differences in worry or
perceived seriousness.
Study 2
Study 1 suggests that people are more inclined to avoid
learning their risk for a medical condition when learning
their risk could require an unpleasant examination. Of
course, a cervical exam and a cheek swab differ in
many ways, not all of which represent a threat to
autonomy. For example, some women may want to
know their risk but would prefer a cervical exam to
be conducted by their own physician, rather than an
unknown physician at the university hospital. In addi-
tion, a cervical exam is more invasive and unpleasant
than having one’s cheek swabbed. To establish the ro-
bustness of our effect, we used a different manipulation
of obligation in Study 2.
80%
High Obligation
Low Obligation
60%
% Avoidance
40%
20%
Study 1 Study 2 Study 3
Fig. 1 Information avoidance
ann. behav. med. (2013) 45:258–263
Methods
Participants
Participants were 82 undergraduate women (Mage 019.5,
SDage 01.4) who participated in partial fulfillment of a re-
search participation requirement.
Design and Procedure
Study 2 was identical to Study 1 with two exceptions. First,
we told all participants that definitive testing for TAA defi-
ciency involved a cheek swab. Second, we varied the treat-
ment obligation. Participants learned that treatment for TAA
deficiency required enrolling in a pill regimen of undefined
length (high obligation condition) or they learned nothing
about treatment (low obligation condition). Thus, the low
obligation conditions in Studies 1 and 2 are identical (i.e.,
they both require a cheek swab and do not describe
treatment).
Pilot participants (N034) evaluated the high and low
obligation conditions using the same eight-item index as
in Study 1 (α for both conditions>.91). They reported that
the pill regimen posed a greater threat to autonomy (M04.5,
SD01.7) than did the unspecified treatment (M04.1, SD0
1.3), t (33)02.26, p0.03, d0.39.
Results and Discussion
As evident in Fig. 1, more participants opted to avoided
learning their risk in the high obligation condition (67 %)
than in the low obligation condition (43 %), X2 (1, 82)0
4.14, p0.04, Φ 0 .23.
As in Study 1, we found no effect of condition on the
extent to which participants worried about developing TAA
deficiency or viewed the condition as serious, ts(80)<.66, p
>.50, r<.08, indicating again that we did not inadvertently
manipulate worry or seriousness. Further, neither of these
variables predicted avoidance behavior (rs<.12) suggesting
that our effects are not due to differences in worry or
seriousness.
Study 3
Studies 1 and 2 demonstrate a robust increase in risk feed-
back avoidance in response to a threat to autonomy. How-
ever, both studies patterned TAA deficiency after
endometriosis. Thus, we did not include men. In Study 3,
we tested the generalizability of our findings by including
men, by varying further our manipulation of obligation, and
by changing the nature of the disease. Doing so ensures that
261
our effect generalizes to men and is not specific to the
symptom constellation associated with endometriosis.
Methods
Participants
Participants were 66 undergraduates (43 women, Mage 0
18.4, SDage 0.74) who participated in partial fulfillment of
a research participation requirement.
Design and Procedure
Study 3 was identical to Study 2 with three exceptions. First,
the sample included men. Second, we modeled the symp-
toms of TAA deficiency after type 2 diabetes (e.g., exhaus-
tion, inability to process certain foods, weight gain) rather
than endometriosis, thereby making the symptoms relevant
to men and allowing us to test the generality of our findings
to a different symptom constellation. Third, we varied be-
havioral obligation by manipulating the duration of treat-
ment for TAA deficiency. Participants learned that treatment
for TAA deficiency required taking a pill daily either for
2 weeks (low obligation condition) or for the rest of one’s
life (high obligation condition).
Once again, pilot participants (N034) evaluated the high
and low obligation conditions using the same eight-item
index (αs>.95) used in Studies 1 and 2. The pilot partic-
ipants reported that a lifetime pill regimen posed a greater
threat to autonomy (M04.6, SD01.7) than did a 2-week pill
regimen (M03.8, SD01.7), t (33)04.33, p0.01, d0.74.
Results and Discussion
Because preliminary analyses revealed no difference in
avoidance between men (30 %) and women (39 %) across
conditions, X2 (1, N066)0.50, p0.48, Φ 0 .09, we analyzed
their responses together. As evident in Fig. 1, more partic-
ipants opted to avoid learning their risk in the high obliga-
tion condition (52 %) than in the low obligation condition
(21 %), X2 (1, N066)06.55, p0.01, Φ 0 .32. Interestingly,
levels of avoidance were lower in Study 3 than in Studies 1
and 2, perhaps because the symptoms of TAA in Study 3
seemed milder (exhaustion, inability to process certain
foods and weight gain vs. pain, infertility, and physical
complications).
As in Studies 1 and 2, we found no effect of condition on
the extent to which participants worried about developing
TAA deficiency or viewed the condition as serious, ts(64)<
1.7, p>.10, r<.11, indicating once again that we did not
inadvertently manipulate worry or seriousness. Further,
262
neither of these variables predicted avoidance behavior (rs
<.22) suggesting that our effects are not due to differences
in worry or perceived seriousness.
General Discussion
The results of three studies confirmed that the more onerous
the behavior demanded by information, the more people
were inclined to avoid the information. Specifically, more
participants avoided learning their results from a risk calcu-
lator when bad news required a follow-up test that was
described as more invasive (Study 1), when bad news obli-
gated undergoing an unpleasant treatment regimen (Study
2), and when the duration of treatment was longer (Study 3).
Our results add to the small but growing experimental
literature showing that people sometimes manage threaten-
ing information by proactively avoiding it [1, 22, 23]. The
research is novel in that it demonstrates experimentally that
people avoid information that may obligate undesired be-
havior, and our findings highlight the important role of
autonomy concerns in information avoidance. Participants
in our study were more inclined to avoid information when
learning the information threatened their autonomy by obli-
gating undesired behavior. As such, our results are the first
to reveal that threats to autonomy can not only provoke
psychological reactance [8, 9] but also prompt avoidance
of health information.
Importantly, by replicating our effect using three different
manipulations of obligation, we rule out several alternative
explanations for our findings. In Study 1, one could argue
that it was the noxiousness of the behavior rather than a
threat to autonomy that lead to greater avoidance in the high
obligation condition. However, Studies 2 and 3 replicated
the effects of Study 1 using a different manipulation of
obligation that did not involve undergoing noxious behav-
ior. In Study 2, one could argue that it is a lack of informa-
tion rather than low obligation that is reducing avoidance.
However, the low obligation conditions in Studies 1 and 3
had explicit information about what behavior was required,
suggesting that it was not simply a lack of information that
produced our effects. Finally, we found no differences be-
tween the low and high obligation conditions in reports of
worry or judgments of seriousness of the disease in any of
our studies, suggesting that our manipulations did not inad-
vertently influence how serious participants found the dis-
ease or how worried they were about developing it. Further,
we found no relationship between worry or seriousness and
avoidance, suggesting that our manipulation, rather than
worry or perceived seriousness, was responsible for the
effects we observed.
We are careful to acknowledge limitations in our find-
ings. For instance, it remains unknown whether behavioral
ann. behav. med. (2013) 45:258–263
obligations might influence avoidance of other types of
information, such as whether one’s relationship partner is
cheating, which can force an unwanted confrontation or
breakup, or whether one has a sexually transmitted disease,
which can force a change in personally preferred sexual
practices. Further, obligation is just one of several factors
that can lead to avoidance of information. Indeed, people are
more inclined to avoid learning risk when a disease is
described as uncontrollable [22, 23] or when it will produce
undesired affect or challenge a cherished belief [1]. In many
contexts, there may be multiple factors that make informa-
tion threatening and prompt avoidance. For example, a
diagnosis may not only obligate an unwanted response,
but also make people anxious or challenge a view of self
as healthy. In such instances, removing or reducing the
obligation may not eliminate avoidance.
Overall, our study offers an important, initial step in
understanding obligation as a motive for information avoid-
ance. We show that people avoid information in response to
multiple threats to autonomy. Likely, these types of threats
to autonomy underlie avoidance of regular pelvic checkups
and cervical cancer screenings for women who find Pap
tests invasive and unpleasant [24], as well as avoidance of
type 2 diabetes testing for people worried about the major
lifestyle changes and unpleasant daily treatment necessitated
by a diagnosis [25]. These types of avoidance represent a
public health concern when early-stage detection of disease
is critical for disease course and control [26]. Our results
suggest that health messages attempting to emphasize the
importance of screening or treatment should not overem-
phasize the behaviors required to diagnose or treat a disease,
as doing so may increase psychological reactance and inad-
vertently decrease screening.
Acknowledgments We thank Kate Sweeny and three anonymous
reviewers for their feedback on this manuscript. This article is based
on work supported by a National Science Foundation Graduate Re-
search Fellowship awarded to Jennifer L. Howell, under grant no.
DGE-0802270, and by an Intergovernmental Personnel Act agreement
between James A. Shepperd and the National Cancer Institute.
Conflict of Interest The authors have no conflicts of interest to
disclose.
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